Is Joan Didion in Denial About Her Daughter's Alcoholism?

Is Joan Didion in Denial About Her Daughter's Alcoholism?

In her memoir, Blue Nights, the author writes movingly about her daughter's death. Did she overlook Quintana Roo's alcoholism?

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Joan Didion with Quintana Roo, 1966

I’m a dedicated admirer of Joan Didion’s work. I’ve studied her nonfiction for half my life. It’s difficult to critique the work of an icon, and it has been difficult for other American writers to question Didion’s last two books, both memoirs—the National Book Award-winning The Year of Magical Thinking, about her first year as a widow, and the recently released Blue Nights, about the premature death of her daughter, Quintana. American reviews of Blue Nights have been universally laudatory, perhaps because it explores the loss of a child in a family that qualifies as American literary royalty (Didion’s late husband was the novelist John Gregory Dunne, whose brother was Dominick Dunne). With just one exception, the reviews overlook a critical fact about her daughter’s life.

I’ve often wondered about Didion’s daughter, who was about my age and who was brought up in much different circumstances, living first in "the beach house" in Malibu and then in posh Brentwood, and later moving to New York City. (I was born in working-class rustbelt territory and grew up in suburban Pittsburgh—generic American Strip-Mall Land.) While in Magical Thinking Didion inquires deeply and thoroughly into her husband’s physical condition, in Blue Nights, Didion goes to some lengths to obscure from her readers, and perhaps even from herself, one fact in particular: it’s likely that her daughter died of the consequences of alcoholism.

Quintana died at 39 of acute pancreatitis. The U.S. National Library of Medicine reports that 70 percent of cases of acute pancreatitis in the U.S. are due to “alcoholism and alcohol abuse.” In a 2009 article titled, “It’s the Alcohol, Stupid,” authors writing for a Nature Publishing Group journal state, “Overuse of alcohol is a major cause of acute and chronic pancreatitis in both developed and developing countries. … Prolonged overconsumption of alcohol for 5-10 years typically precedes the initial attack of acute alcoholic pancreatitis.”

Despite Didion’s skill as an investigator, despite her admissions that Quintana “drank too much” and that she died of acute pancreatitis, the words “alcoholism” or “addiction” are not mentioned anywhere in the book.

In Blue Nights, Didion admits that her daughter drank a great deal in her teenage years, but she repeatedly averts her eyes from the idea that Quintana’s drinking was a critical health problem. Here is an astonishing passage in which the narrator of Blue Nights uses a ten-foot pole to circle around the issue of her daughter's addiction without touching it: "She was depressed. She was anxious. Because she was depressed and because she was anxious she drank too much. This was called medicating herself. Alcohol has its own well-known defects as a medication for depression but no one has ever suggested—ask any doctor—that it is not the most effective anti-anxiety agent yet known."

I had to read these sentences perhaps three times before I understood that, in them, the author of Slouching Towards Bethlehem and The White Album (books I’ve read so many times I can recite many sentences by heart) was making some serious errors in her analysis. Think about what she is saying here: no one has ever said booze is no good at controlling anxiety. “Ask any doctor.” Well, any doctor? I can think of a dozen eminent ones offhand who would counter this claim. As for “no one” ever suggesting this, I have only to key into Google the words “alcohol + anxiety”—the results are legion. Or go to any open 12-step meeting anywhere, any day of the week, to hear people talk about how poorly alcohol controlled their anxiety.

Everyone makes mistakes. But Didion’s journalistic skills are legendary. When she decides to turn her reporter’s eye on a subject, usually no detail is left unexamined, no narrative thread left dangling, so it was the passage above, coupled with a New York story about Didion that ran in advance of the book’s release, that made me want to take a closer look at how addiction is examined—or not examined—in her memoir about her daughter.

It’s a common belief, the idea that we drink to “medicate” our anxiety and depression, though the American Society of Addiction Medicine’s recent definition of addiction counters this idea by classifying addiction as a primary illness in and of itself, perhaps interacting with but not driven by other illnesses.

Didion invests much more attention in the idea that Quintana was mentally ill than in the possibility that her daughter’s alcoholism was her primary problem—or, at least, a health threat equal to that of her mental illness. Despite Didion’s skill as an investigator, despite her admissions that Quintana “drank too much” and that she died of acute pancreatitis, the words “alcoholism” or “addiction” are not mentioned anywhere in the book. Neither, in fact, are they mentioned in the New York story. New York skirts the issue of Quintana’s alcoholism just as Didion does: "At some point it became impossible to figure out whether depression was causing the alcohol abuse or vice versa. One family friend would call it “alcohol personality disorder.”

According to unnamed sources quoted in New York, Quintana drank so much and so often that many people who knew her believe she was drinking before she fell and hit her head, an injury connected with a cerebral hemorrhage that may have contributed to her failing health. But, curiously, the words “alcoholism” or “addiction” are excluded. It’s as though it’s easier to call Quintana mentally ill, easier to discuss the myriad psychiatric disorders with which, Didion writes, Quintana was diagnosed—depression, anxiety, bipolar disorder, obsessive-compulsive disorder, borderline personality disorder, other disorders for which Didion claims in Blue Nights she cannot remember the names (I find Didion’s inability to remember the names of her daughter’s diagnoses difficult to believe, and I find it hard to believe that, if she could not remember, she would not then track them down in the medical record)—than to posit the reasonable idea that Quintana was, indeed, an alcoholic.

I found just one article quoting Didion speaking the word “alcoholic” in connection with her daughter. In a story in the Irish Belfast Telegraph, Didion calls her daughter “an alcoholic” and says Quintana, at 29 or 30 years old, went to Hazelden for treatment. Is it Didion or the American media, or both, then, who are reluctant to make this connection?

“The stigma of addiction is worse than the stigma of mental illness. People with addiction quite often won’t admit they’re addicted,” says Marvin D. Seppala, M.D., chief medical officer of Hazelden in Center City, Minn. “There’s no such term as ‘alcohol personality disorder,’ and it’s not a helpful term.”

I asked Seppala whether he’s seen alcoholics come to Hazelden with previously-recorded psychiatric diagnoses that prove nonexistent, or at least are mitigated, once the alcoholism is treated—once the person abstains and begins to work on recovery.

“What you’re describing is fairly commonplace,” he said. “It can take up to two to three weeks [of abstinence] to see the change.”

The most common situation, Seppala said, is the alcoholic with a 20-year history of drinking whose depression and anxiety has in recent months or years driven her to a psychiatrist, who has prescribed an antidepressant medication and a sleep aid. “They’ve gotten diagnosed with a mental health disorder that doesn’t really exist once they get treatment for alcoholism,” Seppala said.

However, he said, if someone experiences depression as a teenager and begins drinking at a young age—as Didion says Quintana did—then has a recurrence of depression, “and by 30 they’re drinking alcoholically, then they might also have a recurrent depressive illness,” he said. “When the depression starts first, it’s a sign there’s two disorders going on.” Two disorders, not just one.

The cultural reluctance to front the issue of addiction stems from a cognitive dissonance between the way addiction is defined and the way it’s treated, says Paul Hokemeyer, Ph.D., an addictions therapist at the Caron Treatment Center in New York City and a contributor to both the Dr. Oz Show and The Fix. “The problem is, we tell people it’s a brain disease, but then we tell them we have a spiritual solution,” says Hokemeyer, whose practice is oriented toward the Twelve Steps. “Imagine if we said we have a spiritual solution to the disease of cancer,” he said.

Part of the “disease” model of addiction is the evidence that supports a genetic predisposition toward addiction, which many addictions experts believe can be activated by adverse childhood experiences. “There’s a huge connection between trauma, anxiety, and addiction,” Hokemeyer says. “Typically, in 99.9 percent of cases of addiction there is an underlying anxiety disorder or trauma that causes vulnerability [to addiction].”

There’s the genetic component of addiction, Hokemeyer says, “and then there’s the family-of-origin issue—the family system, the family she grew up in.” This is the point at which Quintana’s story—the story of her life and death—verges into deep waters. It can feel uncomfortable and extremely unkind to take a retrospective glance at the parenting practices of a mother grieving her daughter’s early death. “You can look at how she was taught how to manage her uncomfortable emotions,” Hokemeyer says. “If Daddy came home from work and poured himself a drink at the end of the day, she learned that the way Daddy managed stress was through alcohol.”

Important information. Making drinks, Didion writes in a section about how the infant Quintana was adopted, “was what we did in our family to mark any unusual, or for that matter any usual, occasion.” In other words, alcohol was used quite frequently in that family system—to deal with both ordinary and extraordinary occasions. “In retrospect,” Didion continues, “we all drank more than we needed to drink but this did not occur to any of us in 1966”—the year Quintana was born.

Only when I read my early fiction, in which someone was always downstairs making a drink and singing “Big Noise Blew in from Winnetka,” did I realize how much we all drank and how little thought we gave to it.

So, to answer Hokemeyer’s question: Yes, Quintana’s father, John Gregory Dunne, did manage stress through alcohol. Right up to the very end of his life, in fact: on his final evening, after coming home from an extraordinarily stressful visit to the hospital where Quintana lay in critical condition, her father asked for a second Scotch before he had finished his first, then, as he drank, he suffered a massive coronary event that killed him.

Still, Didion apparently remains convinced that her daughter died of causes other than alcoholism. In the Belfast Telegraph, in the same story in which Didion calls her daughter an alcoholic, she also says she believes that her daughter’s acute pancreatitis was caused by (wait for it) a rare case of avian flu.Bird flu.

The power of denial. Especially when mixed with grief. It unfortunately has the ability to distort the thinking of even our most beloved intellectuals and artists and, ultimately, to hide the full truth of their stories.

Jennifer Matesa writes about addiction and recovery on her blog, Guinevere Gets Sober. She writes features and blog posts for The Fix. She is the author of two books of nonfiction about women and health and is at work on a book about her family’s experience with addiction and her own experience getting sober online.

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